Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (2): 278-282. doi: 10.19723/j.issn.1671-167X.2022.02.013

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Validation of the Pollard’s classification criteria (2010) for rheumatoid arthritis patients with fibromyalgia

GAO Chao,CHEN Li-hong(),WANG Li,YAO Hong,HUANG Xiao-wei,JIA Yu-bo,LIU Tian()   

  1. Department of Rheumatology and Immunology, Peking University People’s Hospital, Beijing 100044, China
  • Received:2020-07-31 Online:2022-04-18 Published:2022-04-13
  • Contact: Li-hong CHEN,Tian LIU E-mail:13901007280@163.com;mikle317@163.com

Abstract:

Objective: To evaluate the sensitivity and specificity of Pollard’s classification criteria(2010) for the diagnosis of rheumatoid arthritis (RA) patients withfibromyalgia (FM) in Chinese patients, and to assess the clinical features and psychological status of RA-FM patients in a real-world observational setting. Methods: Two hundred and two patients with rheumatoid arthritis were enrolled from the outpatients in Rheumatology and Immunology Department in Peking University People’s Hospital. All the patients were evaluated whether incorporating fibromyalgia translation occured using the 1990 American College of Rheumatolgy (ACR)-FM classification criteria. Forty two RA patients were concomitant with FM, while the other one hundred and sixty RA patients without FM were set as the control group. Results: There was no significant difference in general demography between the two groups (P>0.05). In this study, the Pollard’s classification criteria (2010) for RA-FM in Chinese patients had a high sensitivity of 95.2% and relatively low specificity of 52.6%. Compared with those patients without FM, RA patients with FM (RA-FM patients) had higher Disease Activity Scale in 28 joints (DAS-28) score (5.95 vs. 4.38, P=0.011) and much more 28-tender joint counts (TJC) (16.5 vs.4.5, P<0.001).RA-FM patients had worse Health Assessment Questionnaire (HAQ) score (1.24 vs. 0.66, P<0.001) and lower SF-36 (28.63 vs. 58.22, P<0.001). Fatigue was more common in RA-FM patients (88.1% vs. 50.6%,P<0.001) and the degree of fatigue was significantly increased in RA-FM patients (fatigue VAS 5.55 vs. 3.55, P<0.001). RA-FM patients also had higher anxiety (10 vs.4, P<0.001) and depression scores (12 vs.6, P<0.001). erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), morning stiffness time and 28-swollen joint counts (SJC) showed no difference between these two groups. Conclusion: The Pollard’s classification criteria (2010) for RA-FM are feasible in Chinese rheumatoid arthritis patients. The Pollard’s classification criteria is highly sensitive in clinical application, while the relativelylow specificity indicates that various factors need to be considered in combination. RA patients with FM result in higher disease activity,worse function aland psychological status. RA patients with FM also have poorer quality of life. DAS-28 scores may be overestimated in RA patients with FM. In a RA patient thatdoes not reach remission, the possibility of fibromyalgia should be con-sidered.

Key words: Rheumatoid arthritis, Fibromyalgia, Classification

CLC Number: 

  • R593.22

Table 1

Demographic characteristics of RA patients with FM vs. those without FM"

Feature RA (n=160) RA-FM (n=42) P
Age/years, M(P25,P75) 64 (56, 71) 62.5 (56, 71.5) 0.779
Disease duration/years, M(P25,P75) 9 (4, 17.8) 11.5 (2, 21) 0.617
Gender, n(%) 0.567
Male 33 (20.6) 7 (16.7)
Female 127 (79.4) 35 (83.3)
Smoking, n(%) 144/160 (90.0) 37/42 (88.1) 0.939
Education, n(%) 0.584
Primary 26 (16.3) 9 (21.4)
Junior 47 (29.4) 11 (26.2)
Senior 41 (25.6) 14 (33.3)
Higher education 46 (28.8) 8 (19.0)
Race, n(%) 0.755
Han 152 (95.0) 41 (97.6)
Others 8 (5.0) 1 (2.4)
Marital status, n(%) 0.536
Married 155 (96.9) 42 (100.0)
Unmarried 5 (3.1) 0 (0)
Occupation, n(%) 0.792
Employed 16 (10.0) 2 (4.8)
Retired 113 (70.6) 30 (71.4)
Other 31 (19.4) 10 (23.8)

Table 2

Clinical and immunological characteristics of RA patients with FM vs. those without FM"

Feature RA (n=160) RA-FM (n=42) P
DAS28, x -±s 4.38±1.37 5.95±1.21 0.011
TJC, M(P25, P25) 4.5 (1, 8) 16.5 (10, 24) <0.001
SJC, M(P25, P25) 1 (0, 3.75) 2 (0.75, 4) 0.470
Morning stiffness/min, M(P25, P25) 15 (0, 60) 25 (3.75, 99) 0.062
CRP/(mg/dL), M(P25, P25) 14.89 (4.10, 36.14) 27.86 (2.95, 54.68) 0.152
ESR/(mm/h), M(P25, P25) 43.50 (17.00, 70.75) 50.50 (16.75, 76.50) 0.518

Table 3

Quality of life and functional status of RA patients with FM vs. those without FM"

Feature RA (n=160) RA-FM (n=42) P
HAQ, M(P25, P25) 0.66 (0.20, 0.90) 1.24 (0.26, 1.50) <0.001
VAS/cm, M(P25, P25) 3 (2, 5) 5 (3, 7) 0.01
SF36, M(P25, P25) 58.22 (47.26, 73.17) 28.63 (19.80, 39.97) <0.001

Table 4

Psychological and fatigue characteristics of RA patients with FM vs. those without FM"

Feature RA (n=160) RA-FM (n=42) P-value
Anxiety 4 (1, 7) 10 (8, 12) <0.001
Depressed 6 (3, 8) 12 (10, 15) <0.001
Fatigue 81/160 37/42 <0.001
Fatigue VAS 3.55 (1.00, 4.73) 5.55 (4.61, 5.91) <0.001
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